LATEST Hand Surgery CERTIFICATION EXAM
OFFERED BY Multiple ABMS Boards —
American Board of Orthopaedic Surgery,
American Board of Plastic Surgery, American
Board of Surgery | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 45-year-old female presents with progressive
numbness and tingling in the thumb, index, and
middle fingers, worse at night. Phalen test is positive
at 20 seconds. Which is the most appropriate next
step?
A) Carpal tunnel injection with corticosteroid
B) Carpal tunnel release surgery
C) Wrist splinting at night and nerve conduction
studies
D) MRI of the wrist
Correct answer: C
Rationale: Initial treatment for mild to moderate
carpal tunnel syndrome is night splinting; NCS
confirms diagnosis before surgery.
2. A 28-year-old male sustains a deep laceration to
the volar aspect of the index finger at the level of the
,proximal phalanx. He cannot flex the distal
interphalangeal (DIP) joint. The proximal
interphalangeal (PIP) joint flexes normally. Which
tendon is injured?
A) Flexor digitorum profundus (FDP)
B) Flexor digitorum superficialis (FDS)
C) Flexor pollicis longus (FPL)
D) Lumbrical
Correct answer: A
Rationale: FDP is the only flexor of the DIP joint; loss
of DIP flexion indicates FDP injury.
3. A 32-year-old male sustains a closed fist injury
(fight) with a laceration over the
metacarpophalangeal (MCP) joint of the small finger.
He has purulent drainage and fevers. X-ray shows a
fracture of the 5th metacarpal neck (boxer's
fracture). Which is the most likely organism?
A) Eikenella corrodens
B) Staphylococcus aureus
C) Pasteurella multocida
D) Streptococcus pyogenes
Correct answer: A
,Rationale: Human bite ("fight bite") over the MCP joint
is often infected with Eikenella corrodens, an
anaerobe.
4. A 55-year-old female with rheumatoid arthritis
presents with inability to extend the ring and small
fingers at the MCP joints. The deformity is
correctable passively. Which is the most likely
diagnosis?
A) Rupture of extensor digitorum communis (EDC)
tendons
B) Ulnar drift
C) Swan-neck deformity
D) Boutonnière deformity
Correct answer: A
Rationale: Rheumatoid arthritis causes tenosynovitis
and attrition rupture of extensor tendons, typically
ring and small fingers.
5. A 22-year-old male sustains a hyperextension
injury to the thumb during a basketball game. The
thumb MCP joint is swollen and unstable radially.
Stress testing shows 40 degrees of radial deviation.
Which ligament is torn?
, A) Ulnar collateral ligament (UCL)
B) Radial collateral ligament (RCL)
C) Volar plate
D) Adductor aponeurosis
Correct answer: B
Rationale: Hyperextension with radial deviation
suggests radial collateral ligament (RCL) injury; UCL
is injured in valgus stress (skier's thumb).
6. A 35-year-old female presents with a slowly
enlarging, firm, fixed mass on the palmar aspect of
the wrist. Tinel sign is positive over the mass.
Electromyography shows prolonged distal motor
latency of the median nerve. Which is the most likely
diagnosis?
A) Lipoma
B) Ganglion cyst
C) Median nerve schwannoma
D) Carpal tunnel syndrome without mass
Correct answer: C
Rationale: Schwannoma of the median nerve
presents as a slow-growing, firm, mobile mass with
Tinel sign and nerve dysfunction.
OFFERED BY Multiple ABMS Boards —
American Board of Orthopaedic Surgery,
American Board of Plastic Surgery, American
Board of Surgery | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 45-year-old female presents with progressive
numbness and tingling in the thumb, index, and
middle fingers, worse at night. Phalen test is positive
at 20 seconds. Which is the most appropriate next
step?
A) Carpal tunnel injection with corticosteroid
B) Carpal tunnel release surgery
C) Wrist splinting at night and nerve conduction
studies
D) MRI of the wrist
Correct answer: C
Rationale: Initial treatment for mild to moderate
carpal tunnel syndrome is night splinting; NCS
confirms diagnosis before surgery.
2. A 28-year-old male sustains a deep laceration to
the volar aspect of the index finger at the level of the
,proximal phalanx. He cannot flex the distal
interphalangeal (DIP) joint. The proximal
interphalangeal (PIP) joint flexes normally. Which
tendon is injured?
A) Flexor digitorum profundus (FDP)
B) Flexor digitorum superficialis (FDS)
C) Flexor pollicis longus (FPL)
D) Lumbrical
Correct answer: A
Rationale: FDP is the only flexor of the DIP joint; loss
of DIP flexion indicates FDP injury.
3. A 32-year-old male sustains a closed fist injury
(fight) with a laceration over the
metacarpophalangeal (MCP) joint of the small finger.
He has purulent drainage and fevers. X-ray shows a
fracture of the 5th metacarpal neck (boxer's
fracture). Which is the most likely organism?
A) Eikenella corrodens
B) Staphylococcus aureus
C) Pasteurella multocida
D) Streptococcus pyogenes
Correct answer: A
,Rationale: Human bite ("fight bite") over the MCP joint
is often infected with Eikenella corrodens, an
anaerobe.
4. A 55-year-old female with rheumatoid arthritis
presents with inability to extend the ring and small
fingers at the MCP joints. The deformity is
correctable passively. Which is the most likely
diagnosis?
A) Rupture of extensor digitorum communis (EDC)
tendons
B) Ulnar drift
C) Swan-neck deformity
D) Boutonnière deformity
Correct answer: A
Rationale: Rheumatoid arthritis causes tenosynovitis
and attrition rupture of extensor tendons, typically
ring and small fingers.
5. A 22-year-old male sustains a hyperextension
injury to the thumb during a basketball game. The
thumb MCP joint is swollen and unstable radially.
Stress testing shows 40 degrees of radial deviation.
Which ligament is torn?
, A) Ulnar collateral ligament (UCL)
B) Radial collateral ligament (RCL)
C) Volar plate
D) Adductor aponeurosis
Correct answer: B
Rationale: Hyperextension with radial deviation
suggests radial collateral ligament (RCL) injury; UCL
is injured in valgus stress (skier's thumb).
6. A 35-year-old female presents with a slowly
enlarging, firm, fixed mass on the palmar aspect of
the wrist. Tinel sign is positive over the mass.
Electromyography shows prolonged distal motor
latency of the median nerve. Which is the most likely
diagnosis?
A) Lipoma
B) Ganglion cyst
C) Median nerve schwannoma
D) Carpal tunnel syndrome without mass
Correct answer: C
Rationale: Schwannoma of the median nerve
presents as a slow-growing, firm, mobile mass with
Tinel sign and nerve dysfunction.
